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Aetna Medicare Dual Complete (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual Complete (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Dual Complete (HMO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Dual Complete (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Houston and Surrounding Counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Dual Complete (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Aetna Medicare Dual Complete (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Aetna Medicare Dual Complete (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Aetna Medicare Dual Complete (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $17.60. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9350.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Aetna Medicare Dual Complete (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you move to the next coverage phase. If you qualify for the low-income subsidy (LIS), your monthly premium for Part D is $17.60. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered Part D drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Aetna Medicare Dual Complete (HMO D-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $1830 copay per admission, while emergency and urgent care services have copays of $110 and $45, respectively. Many services, including primary care visits, home health, and preventive services like an annual physical, have no copay. Outpatient services, hearing, vision, dental, and medical equipment have coinsurance requirements. The plan also provides coverage for transportation, home infusion, and over-the-counter items with a monthly allowance of $90. However, some services like cardiac rehabilitation, additional hospital days, and certain dental and vision services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For a Medicare-covered stay, the copay is $1830 per admission or stay, and there is no coinsurance. Additional Days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, and outpatient substance abuse services, are covered with coinsurance ranging from 0% to 20%. Outpatient blood services have a 20% coinsurance, and the plan waives the three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Dual Complete (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Dual Complete (HMO D-SNP). Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay and are limited to 24 one-way trips per year using rideshare services, bus/subway, or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Dual Complete (HMO D-SNP) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay; both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.
Primary Care See details
The Aetna Medicare Dual Complete (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services with no copay for many services. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services are covered, including an annual physical exam with no copay. Additional preventive services include Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Wigs for Hair Loss Related to Chemotherapy, some of which may have a copay.
Hearing Services See details
Hearing exams and prescription hearing aids are covered under the Aetna Medicare Dual Complete (HMO D-SNP) plan. Hearing exams have a coinsurance of at most 20% for routine hearing exams and a copay for Medicare-covered benefits. Prescription hearing aids have a maximum benefit of $1,000 per year with no copay for all types of hearing aids, however, the inner ear, outer ear and over the ear hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams and other eye exam services have no copay. Eyewear has a 20% coinsurance, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay, with a combined maximum plan benefit of $255 every year.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, prosthodontics, fixed, and oral and maxillofacial surgery are covered with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare Dual Complete (HMO D-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Dual Complete (HMO D-SNP) plan, but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, and Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Supplies have no coinsurance and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, lab services, all radiological services, diagnostic radiological services, therapeutic radiological services, and outpatient X-Ray services, are covered. Diagnostic procedures/tests, lab services, therapeutic radiological services, and outpatient X-Ray services have a coinsurance of at most 20%, while diagnostic radiological services have no coinsurance. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Dual Complete (HMO D-SNP) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Dual Complete (HMO D-SNP) plan. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but prior authorization is required. The plan does not cover additional days beyond Medicare-covered SNF services or non-Medicare-covered SNF stays.
Other Services See details
The Aetna Medicare Dual Complete (HMO D-SNP) plan covers Over-the-Counter (OTC) items with no copay, and a maximum benefit coverage amount of $90 per month. Other services like acupuncture, EPSDT services, and many more are not covered.
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